Lantus question

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Kerri2455, Jan 3, 2018.

  1. Kerri2455

    Kerri2455 Member

    Joined:
    Dec 26, 2017
    Hi everyone
    I have read that after 28 days of use the Lantus Sola Star Pen should be thrown out. Does everyone do that? I assumed this was because the drug manufacturer just wants to sell more but then a friend told me it could be because its stability isn't what it is the initial 28 days. Any ideas?

    Also, does everyone give the insulin right after eating or do you want a set time and then give the insulin? I'm told its a slow release into the system which is good, but curious if i am to wait a set time period after he eats or just give to him when its clear he's had his fill.

    THANK YOU
    Kerri
     
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  2. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Hi Kerri.

    Not here. That guideline is intended for humans, because they do not refrigerate the pen. Here, since we use a syringe to draw the insulin, instead if the pen's needle, we refrigerate it and most people use every drop. Properly handled, it can be good up to 6 months.

    We recommend TFS - Test, Feed, Shoot. Most people do it all in about ten minutes, but it varies, depending on the cat. Once Cinco had his face in his bowl, we went shot. Some cats don't like to be bothered when eating, so you have to see what works with your cat. Because onset with Lantus isn't until about +2 to +3, you do have some time to get the food in, but we recommend that once you are sure they will eat, go ahead and shoot.
     
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  3. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Thanks for all this good info. I haven't started the testing before eating part because I am learning and his ears don't bleed well so i need to warm them up first and at 6 am I am half asleep still so i need to establish a routine.

    I don't refridgerate the lantus.....i read that only what is not used and being stored should be refrigerated but the pen used doesn't need to be. UH OH. Is that not ok? Is it different than what they say for humans as obviously this is their intended use.
     
  4. Myagi and Heidi

    Myagi and Heidi Member

    Joined:
    Oct 30, 2017
    Hi Kerry. I hit start on the coffee pot, toss the rice sock into the microwave for 24 seconds, pull the lantus out of fridge and draw his dose into syringe, then carry all with my coffee back into room where Myagi is waiting impatiently for his test. :) a rice sock will make the ear warming quicker and protect your fingers from poking!
     
  5. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Jul 25, 2016
  6. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    The instructions that come with the pen say not to refrigerate because the cold air damages the needle mechanism. Since we don't use the needle that comes with it, we don't have to worry about that. Refrigeration will extend the useful life of Lantus, so yes, keep it in the refrigerator.

    I strongly encourage you to get that routine established ASAP. Shooting without testing is like playing Russian roulette. How do you know it's safe to shoot if you don't test? I'm not being critical of you - just want you to understand the importance of testing.

    Kerri, I haven't been on the Board much since you joined - away for the holidays - so I didn't get to add my "Welcome to L&L Land" post. So here it is: we put together a post for new members, to help them get comfortable with this Forum. Have a look when you can. http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/ Read all the stickies at the top of the page, then read them again. There is a TON of info there, and it takes a while to absorb it. Ask lots of questions - the only dumb question is the one you don't ask.

    We're glad you found us.
     
  7. Chubba

    Chubba Well-Known Member

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    Apr 30, 2017
    Welcome! :bighug:
     
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  8. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    HI Kerri, I would like to extend a nice Welcome to you also. Please keep asking questions as that is how we all learned and we are here to help one another.

    Can we get you to set up a Spread Sheet? It will help you to see how a dose is working for kitty ( sorry, I don't know your babie's name) and will help you to keep track of everything. If you need help setting it up, please ask and someone will help you. I needed help with mine as I am a tech mo-mo.

    Also, if you could set up a signature like the rest of us have with all pertinent information in it, like date of diagnosis, what insulin, age of kitty, any medical issues, what time zone you are in and any other info you'd like to share within the amount of lines allowed.

    Glad you are here!
     
    Last edited: Jan 3, 2018
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  9. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Thanks Bobbie! I have no idea how to start a spread sheet. I do have a calendar at home that i have been monitoring the levels with but we don't have consistent testing just yet but we are trying. I can only test AM before work, PM after work and once more at night if need be but am gone all day so don't have the ability to check from 7-5.

    I don't know how to set up a signature line either. I think maybe in my profile area?

    Kitty is Oliver, he will be 12 in June and he's on Lantus.
    We had him yesterday at the vets office for our second curve so we can pin point the right dosage for him and his first level was in the 300's after breakfast and insulin (2 hrs after insulin), then it went to the 200's and then when i picked him up at 4:30 it was 80! We tested again once home and he had eaten and it was 130 so no insulin last night but then this AM it was 466 so he got 3 units after he ate. Crazy his swings. The vet thinks he may be a kitty who has insulin in the morning and a smaller dose, if any, at night so i will test when i get home before feeding and text her his number.
     
  10. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Thank you so much! Ill check out the link for sure.
    I know i need to get a routine down, i was hoping it would be easier to test him but I have trouble with his ears not bleeding, need to warm them up first and i need to figure out the best way to get this all done and i have 5 other cats and 3 dogs and they all want to eat RIGHT THEN. They are nuts! LOL.

    Thanks for not minding all my questions! Appreciate everyone's help!
     
  11. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
  12. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Thanks! I have lots of rice so will make up a rice sock....... I think my issue is i need two hands to help since i have so many cats who demand feeding the moment they see me stir. I am working to get a routine down. We are on the 4th week of this and its starting to come together. Routine for cats and humans is important so that's my goal the new week. Appreciate the advice!
     
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  13. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Go to the top right of the page and find your sign on name...there's a drop down menu...choose "Signature" and a new box will pop up.

    We like to have stuff like:

    Your name/cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues? and a general location.

    Then when you get your spreadsheet set up, you add the link to your signature too (if you need help, feel free to send me a private message. I can set it up for you in about 30 seconds once I have some information. Just click on my name and choose "Start Conversation")
    signature1.PNG
     
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  14. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Ill try this now. THANKS!
     
  15. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Hey Kerri! Glad that Chris gave you some instructions. If you have trouble setting up the Spread Sheet (SS) just yell and someone will help you get it set up.

    Guess what? I used to live in Oceanside CA and San Diego Zoo was the first zoo I ever remember ( I was around 8 years old) and that zoo set a standard for zoos that can not be replicated. :)
     
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  16. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    I certainly will make sure to ask for help with the spread sheet! THANKS

    Small world....Oceanside is just up the freeway from here. :)

    THANK YOU!
     
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  17. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Good job with the signature!
     
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  18. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Hi Kerri and Oliver,

    Welcome to LL.

    Just wanted to clarify, if you are using the solarium star pens and needles then it's not recommended to refrigerate them as it will affect the dosing mechanism of the pen needles.
    You should probably look into getting syringes (if you haven't already) so you can change dose in 0.25u steps. With The pen needle you can only change in whole steps and this is too much for a cat, you run the risk of skipping past a good dose.

    I have a few questions.

    That was some drop in BG at his second curve, just curious how many hours past the his shot was that 80?
    Did you shoot 3u on the day you run the curve?
    How long has he been on lantus? On 3u?

    I think it would be a good idea for you to start home testing asap, given that he went so low at the vets on that curve that was run.

    Do shout if you need help with the spreadsheet.
     
  19. Kerri2455

    Kerri2455 Member

    Joined:
    Dec 26, 2017
    Thanks Gill and George!

    I don't refrigerate the pen, good there and i do have left over needles from 15 yrs ago when i had a diabetic kitty so i have those should i need to draw out the insulin.

    So Oliver ate breakfast yesterday and was given 3 units. He went to the vet at 8 and they tested his blood at 8;30 i think they said. His insulin was at 6:30. It was in the 300's. Don't have exact numbers. They then tested around noon i believe and it was in the 200's. then at 4:30 it was 80 and they did double check because my vet was surprised.
    We took him home, fed him and then checked his blood, it was at 130 so my vet said no insulin for the night. This morning he was 466!
    He's been on 3 units approaching 2 weeks now. Initially on 2 units. My vet thinks he may need 3 in the AM and less at night.

    I will check his blood before he eats tonight to see if we need to give him insulin and then text the number to my vet who will let me know what to do.

    We will certainly be testing before feedings, its an adjustment for us but we will make that happen.

    THANKS for all the help!
     
  20. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    That's good, are they u100 syringes? You can only use u100 syringes with lantus.

    With that 80 at the vets I would strongly recommend you getting a midcycle test or two in. Fwiw, cats often have higher BG at the vets due to stress, so he may be going significantly lower than that at home. By the time he is showing symptoms you can be in a very tricky situation.
     
  21. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Kerri, 3 units is a big starting dose. How much does Oliver weigh? His big swings could be because he is getting too much insulin and without testing more you won't know how low that dose is taking him. When kitties go too low they will bounce back up to a higher number because their bodies will release counter regulatory hormones to keep them safe. So, what might look like not enough insulin could be too much.

    Most kitties are started around 1 unit to 1 1/2 units twice a day. Lantus needs consistency in order for the depot to form so shooting the same dose AM and PM is advised. So, finding a dose that you can shoot the same amount twice a day is recommended.

    If you use U 100 syringes to draw the insulin out of the pens rather than the needles that come with them, you can then refrigerate the pen and they can last up to 6 months refrigerated. Otherwise, the pen will only last you 28 days before you lose its efficacy.

    ETA: Let's see what some others think about the dose possibly being too high.
     
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  22. Phoebes

    Phoebes Well-Known Member

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    Jan 16, 2017
    Welcome Kerri and Oliver. I would echo what Bobbie says. 3 units is a big dose for new kitty. Your vet made that decision based on the numbers at the vets. But stress can raise those bg due to the stress. Might beworth you starting back at 1 1/2units. I know you have Come here with all these strangers suggesting you go against what your vet says. But these people eat live breathe diabetes. Vets get little training in feline diabetes. I was just like you. Did not want to go against my beloved vet. But the people here will help and guide you safely with your kitty. Ask away. Welcome again.it's the best place you never wanted to be. Head bumps
     
  23. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Me again, another thing is that I believe the two foods you are feeding are too high in carb count. We recommend feeding wet food and keeping the carbs under 10% . Higher carb food will result in kitty needed a higher dose of insulin. So, check the carbs and maybe someone else here will know just how high the count is.
     
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  24. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    But to add to what Bobbie has said, if you do change food, transition slowly, reducing carb intake can dramatically reduce insulin requirements, so a dose that has been safe can end up taking a kitty too low, and they can suffer a symptomatic hypo. We have seen some dramatic cases where this has happened.

    So if you reduce carbs, do it slowly and be extra vigilant (ie make sure you are getting enough midcycle data to know how low the dose is taking your cat, kitties on lantus will often have their lowest number around +6, though you can see nadirs as early as +1 and as late as +12:rolleyes:), you may need to reduce insulin dose accordingly, depending on what the numbers do.
     
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  25. Alicia & Maggie

    Alicia & Maggie Well-Known Member

    Joined:
    Jun 17, 2017
    Welcome Kerri! You must be overwhelmed with all the info thrown at you, but keep reading and rereading the stickies at the top of the Lantus/Levemir page. Know that there is a wealth of knowledge and experience to help you help Oliver.
     
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  26. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Hi everyone-I appreciate all this information and thought just reply to all in one post might be easier?

    So first off his weight was 12.6 lbs appx when diagnosed. He was 13 at the vet's Wednesday so he's gained some weight.

    When we took him to the vet Wed for his curve, i had given him the 3 units (we did start off with 2 units when first diagnosed) after testing him and he was in the 400's. Sorry i don't have exact numbers. At the vets they tested him around 9 and he was in the 300's. Then early afternoon he was in the 200's. When i picked him up they tested him before going home and he was 80! They checked twice. Because he was so low, we fed him and took his BG after eating and it was 103 so the vet said no insulin.
    The next morning, Thursday, we took his BG and it was 477. He got is insulin like normal then. Thursday evening we tested him before food, he was at 513 which freaked me out. Yesterday was the first day i left food out for them though so i thought MAYBE it was the food. I left some of the DM dry food thinking his low from Wed was because he needed food. Could this high be due to the dry food left?
    We tested him at 9pm just out of curiosity and he was at 476 after his insulin earlier that night.

    This morning my vet had me draw out the 3 units from the pen with the u100 syringe and dose him that way. We checked his BG first and it was 457.
    Tonight we will test before feeding and see where we are at.

    Regarding the food, he has a VERY sensitive stomach so we had given him the fancy feast and merrick mixed as i don't really like giving the junk food and wanted something healthier mixed in. He cant handle FF, he had horrible diarrhea. So we now are back on the high fiber food mixed with merrick which is 4 or 5 carbs i calculated but the royal canin high fiber is a bit higher, i think its 9 or 10. I need to slowly remove the high fiber food but not until we have normal stool and last night he had a cow patty (probably due to the DM dry he isn't used to). So we have this issue PLUS the diabetes both needing to be controlled.

    I would like to not feed the high fiber food and maybe just use Merrick but worry he cant handle that food but wont know until he is weaned off the mixture only on to the Merrick.

    I appreciate your help and time reading all this.

    THANKS ALL!
    Kerri/Ollie
     
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  27. Alicia & Maggie

    Alicia & Maggie Well-Known Member

    Joined:
    Jun 17, 2017
    To get an accurate BG number before injecting, it is important that he isn't fed for 2 hrs. before the pre-shot test. Are you withholding food 2 hrs. before this test? The objective with this test is to see where his BG is on his own so you know if it is safe to shoot.
    Yes, dry food will cause a higher BG, but Oliver is also probably "bouncing" because his pancreas isn't use to insulin or the lower BGs it creates, so it panics and dumps glucose into the blood. More experienced members will chime in and give you a better explanation than I can! :)
    You will want to slowly transition him to an all canned low-carb diet (5% or lower is a good place to start) after he gets back to normal stool. This transition can lower the BG significantly, so you'll have to watch insulin dosages so as not to give too much. Here's a link to nutritional info on many brands of canned cat foods: https://docs.google.com/spreadsheet...m6PPfEUz9YmzMGMxkmcBk6uRR0/edit#gid=113878384

    You'll want to choose one of two methods to try to achieve regulation for Oliver: Tight Regulation, http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/ or Start Low, Go Slow (SLGS), http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/. You'll also need to set up a spreadsheet to record your daily doses and BGs. This provides valuable data for you and for members when you as for help. Here's a link to do that. If you need help setting it up, just post here and someone will respond. http://felinediabetes.com/FDMB/thre...te-a-ss-and-link-it-in-your-signature.130337/
    Here's a very generalized summary of this board's approach to finding an effective dose:
    test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    test at least once near mid cycle and at bedtime daily to see how low the BG goes
    do extra tests (your own curve) on your days off to get data to fill in the holes
    if indicated by consistently high numbers, increase the dose by no more than 0.25 u at a time so you don't accidentally go past a good dose
    post here for advice whenever you're confused or unsure of what to do
     
  28. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Thanks!
    I do withhold food before his AM testing as they eat it before like midnight i would guess and then there is no food in the AM when we go downstairs to eat.
    As for food in the evening before testing, I had been withholding food but then yesterday for the first time i did leave dry food out for him to eat, along with the 5 others, as he is used to always having dry food avail. I had not been doing this until yesterday thinking he may need a snack while i am gone. I work 8 hrs a day and am gone a total of 9 between leaving for work and getting home, so i was afraid when he went to 80 at the vets, he needed a mid day snack.

    Does everyone just feed morning and night with no food during the day? I cant use a food timer thing as i have 6 cats and will have no idea who ate what so that wont work and honestly, locking Oliver up is the last thing i want to do. I believe he's eating enough AM and then PM to not need daytime feedings but could he need the food?
    There has only been the one time that he was low, all other testing he has been high, before eating so to me that seems like he doesn't need to eat?

    I will find a food for him once his IBD issue is clear and he's normal, i will slowly transition him to only low carb wet and then i do have the Purina DM dry which i know is higher in carbs but i was told the carbs are slowly released through the day so its not a big rush of carbs at once, so its ok for him to eat that as he is a dry food junkie.

    Does ANYONE use dry as a snack? treat?

    THANK YOU
     
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  29. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    he is eating the Merrick Perfect Bistro chicken which is very low carb so that's a plus. :)
     
  30. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    Having multiple cats does make it hard. I have two so, I ended up getting two food safes but, 6 would be expensive and where would you put them all ? I was only feeding Bubba twice a day in the beginning of his FD journey but soon realized that in order to help out his pancreas, I would need to feed multiple times a day and especially during the times where he was getting too low from a dose and I needed to steer him up some from lower numbers.

    For diarrhea a lot of us give our kitties 1 tsp. of pure canned pumpkin ( not the pie filling one with all the spices and sugar) twice a day mixed right into their food . It also helps for the opposite problem of constipation.
     
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  31. Alicia & Maggie

    Alicia & Maggie Well-Known Member

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    Jun 17, 2017
    Glad the Merrick's is low carb!
    Most here feed several smaller meals and many here use timed feeders. Hopefully some of them will let you know how they handle timed feeders with multiple cats. Several small meals help a cat to "surf" (meaning to have a gentler, smaller curve) by counteracting the BG drop the insulin produces. It can also help prevent a cat's BG from dropping too low.
    Many use freeze dried treats. Dry takes much longer to pass through the body and doesn't provide the moisture cats need.
     
  32. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    We use canned pumpkin at the rescue i volunteer with for kitty's with bowel issues so if that's safe for a diabetic ill get some this weekend for sure. I wasn't sure.
    I'm wondering if i left a small amount of food out it might be ok but then not being home i wont know who eats it and when BUT i do have a video camera app i can set up on my ipad and monitor from my phone and maybe watch to see who eats and when.......

    And the feeders, not only do i have 6 cats i have 3 dogs SO, the food cant go on the ground. I have many obstacles. LOL
     
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  33. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    If i were to leave out a small amount of dry though would that be ok to get him through the day should he need it? I can set up a camera in the kitchen to watch and see who eats so i can monitor that a bit better and could leave frozen wet food out in bowls too. I do make sure to add water to the canned food to help with the water he's consuming and i still see him drink quite a bit from time to time. :(
     
  34. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    Rather than locking him up and seperating him from his buddies, another option is to put his food in a room to which he only has access to, via a cat flap for instance.

    That's what we have done but in reverse, I feed my kittens in the utility room, they have access to food all day so they can graze. George my diabetic (in remission) gets his in his autofeeder, he's quick when there is food involved as soon as he hears the feeder turn he's on it, so the kittens don't get a look in. So with that set up I can keep George out of the kitten food, that's better for his health and his waistline.


    The only issue with the dry is that it is high in carbs. That said given the results of the curve the other day it was a good idea to leave some out for him to nibble on should he get hungry.

    You should know that though some cats look for food when their BG is dropping, some don't.
     
  35. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    I wish i had the option to separate food from him yet leave him out with the other. I don't have a way to set that up.
    I have seen however feeders that are microchip sensitive and will drop food when a certain chip is present. They are expensive so i would do this as a last resort.

    Normally everyone eats and walks away, i just need to see who it is eating during the day and how much to decide whether to leave out food and how much.
    I can leave out wet food too, freeze some and then pull it out when i go to work and just try to ensure its enough for everyone to have some. I have a few piggy kitties.

    So much to learn and figure out so we can get him regulated! Its a bit overwhelming right now but all this help and suggestions are much appreciated!
     
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  36. Alicia & Maggie

    Alicia & Maggie Well-Known Member

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    Jun 17, 2017
    It would be better to leave frozen canned I think, but for now, as you are sorting everything out maybe you could leave that as the last thing to change. Good idea to set up the camera to see who's eating what.
    Great that you add water to the canned food. The excessive drinking will decrease as he get more regulated.
    You are asking lots of good questions! You are off to a good start for Oliver. :)
     
  37. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    Thank you Alicia! Its a lot of information to digest but everyone has been so helpful which is amazing! I can leave frozen canned out, I will try that and will post the camera to see who eats what and how much Oliver eats.

    Thanks!!
     
  38. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    So seems drawing out the insulin from the pen has a better affect than using the pen alone. Weird but the past three dosings and testing prior his numbers are lower- 328 this AM which is his lowest morning read before food yet!!
     
  39. Alicia & Maggie

    Alicia & Maggie Well-Known Member

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    Jun 17, 2017
  40. Kerri2455

    Kerri2455 Member

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    Dec 26, 2017
    The problem with the spreadsheet is I only have my iPhone to set that up on and it’s too of small fornme see what I am doing.
    I may be able to use my work computer but so many sites we are blocked from at work that I may not be able to.
    I can try during the week on my lunch break.
     
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  41. Alicia & Maggie

    Alicia & Maggie Well-Known Member

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    Jun 17, 2017
    Gotcha!
     
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